Jornal de Toxicologia Clínica
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Prosthetic Hip-associated Cobalt Toxicity and Refractory Anaemia: An Unusual Hookup

Ankita Sheoran*, Prabhat Kumar Singh, Nishant Sharma, Pulin Kumar Gupta

Owing to the wear and tear phenomenon in patients with metal-on-metal implants, release of the metal ions and consequent deposition of these metal ions in the surrounding muscle, followed by subsequent leaching into the systemic circulation, causes various side effects. It is most commonly seen with metals like cobalt and chromium. Cobalt toxicity usually presents with cardiomyopathy, polyneuropathy, bilateral optic neuropathy, bilateral sensorineural hearing loss, thyroid disorders and polycythaemia.

Here, we report a case of a 38-year male, diagnosed case of axial spondylarthritis with bilateral hip replacement, and misaligned left hip implant, presented to emergency with progressive dyspnoea. Although he did not have the typical manifestation of cobalt toxicity, it was diagnosed as anaemia with polyneuropathy, secondary to cobalt toxicity, based on serum and urine cobalt level. Change of hip prosthesis resulted in decline in serum cobalt levels and gradual improvement of anaemia and other symptoms. The case presents as first ever reported case of recurrent anaemia due to cobalt toxicity. Therefore, it is important that clinicians be aware of such systemic manifestations in order to make a prompt diagnosis, enabling effective and timely intervention to reduce associated morbidity.